The Process of Stigmatization - Essay Example

INTRODUCTION Aside from their signs and symptoms, psychiatric patients also suffer from the negative stereotypes given to them by society. In fact, despite depression and anxiety disorders having better acceptance in the society, schizophrenia, the most stigmatized disorder, is still associated with unpredictability, aggression, illogical stupid, and capable of inflicting harm to oneself and others (Schulze and Angermeyer 469). This paper examines the 1) process of stigmatization, 2) the types of stigma patients and relatives experience, 3) the effects of this stigma, specifically to receiving psychiatric help, and 4) the different interventions studied for their effects in lowering stigma or its effects. The process of stigmatization In stigmatization, attributes that are unusual are identified and labeled. Subsequently, labeled individuals are thought to have other negative characteristics, even if they really do not have those. In fact, in analogue behavior studies in which participants were observed in their interactions with people, who, they were made to believe, have psychiatric conditions, the subjects scored poorly in test performances and stigmatizing perceptions, despite the absence of any suspicious symptoms throughout the interaction. In effect, people regarded as normal stay away from the labeled ones based on assumed negative attributes associated with the latter (Piner and Kahle 808). Other approaches to mentally ill individuals are assumption of being less competent and subsequently advising to lower expectations in life (Schulze and Angermeyer 300). Dimensions of stigma Individuals with schizophrenia suffer from four types of stigma, as identified by Schulze and Angermeyer (299) in their focus group study of schizophrenic patients, relatives and mental health professionals. Interpersonal interaction Schulze and Angermeyer (304) define it as stigma in the context of social relationships. According to the study of Schulze and Angermeyer (309), it comprises about 40% – 50% of the stigmatization experienced by patients, relatives or mental health professionals. In surveys among the general public, the majority would refrain from entering social relationships with schizophrenic individuals and recommending them for jobs. Similarly, in other experimental studies in which participants reveal their history of past or present psychiatric condition, these people were found to have more difficulty in employment, renting an apartment, or being accepted by community organizations (Farina, et al. 108 ; Page 193). This was supported by a study determining the effects of stigma from patients’ perspective, which found that for most schizophrenic individuals, their condition resulted to a decrease in their social contacts, especially if presenting with medication side effects, such as involuntary movements and weight gain (Schulze and Angermeyer 305). Those who manage to rent their homes experienced difficulties with landlords, resulting to eviction and accusation of misconduct. In fact, schizophrenic individuals felt that they are treated by society as “scapegoats”, being first to be blamed for problems (Schulze and Angermeyer 304). In fact, even health professionals are felt by schizophrenic individuals to be discriminating against them. Specifically, they felt that these healthcare providers are disinterested with their feelings, concerns, ideas and needs. Their physical complaints are dismissed as psychogenic (Schulze and Angermeyer 305). Public image of mental illness Media is a powerful tool, in terms of information dissemination and changes in behavior. This is apparent in looking at how psychiatric patients are dealt with by the society. The reality and perception of stigmatization are further aggravated by newspapers, television shows and feature films. Attributing heinous, purportedly unmotivated crimes to mentally ill individuals further justify the perception of society that schizophrenic individuals are harmful (Allen and Nairn 55). In addition, such ideas from media are seen by psychiatric patients as unwelcoming social attitude toward them. The fear of rejection is enough for them to avoid social contacts (Schulze and Angermeyer 306). Aside from causing harm, another misconception perpetuated by media is that mental illness and mental retardation is the same. Patients are thus regarded as incompetent, irresponsible and with below-average intelligence (Schulze and Angermeyer 306 - 307). In addition, there is also an unfair focus on somatic disorders relative to mental illnesses, so much that it seems like psychiatric conditions are not real problems. Indeed, there are fewer public information campaigns, public discussion and support services for the benefit of mentally ill patients and their families (Schulze and Angermeyer 307). In fact, even mental health professionals consider the negative public image as the most significant stigma attached to psychiatric patients, because it causes dishonesty during job search situations and reluctance to seek psychiatric care (Schulze and Angermeyer 310). Structural discrimination According to Schulze and Angermeyer (307 - 308), stigmatization has reached a point where it is already ingrained in social structures and policy-making. The subpar quality of mental health services, including the lack of community-based and out-patient services, as a result of inequitable resource allocation in the healthcare system is regarded as the strongest form of structural discrimination. Currently, budget for mental health services are limited to mediations and diagnosis. In addition, receiving health insurance coverage for psychotherapy and community-based psychiatric care is more difficult compared to the more common processing of coverage for individuals about to undergo surgery or long-term medications. As a result, families of psychiatric patients have a significant financial burden. In fact, the relatives’ experience of stigma is dominated by the perceived poor treatment they receive (Schulze and Angermeyer 310). Aside from poor allocation of financial support to these individuals, structural discrimination occurs because it is more difficult for mentally ill individuals to be involved in any economic activity more so to achieve economic success, which is important to the perceived achievement-oriented and performance-based social integration (Schulze and Angermeyer 308). Access to social roles The most common social role psychiatric individuals are denied from is professional roles. Psychiatric treatment or even consult becomes a reason for mistrust and denial of skills. As a result, they at times do not admit their psychiatric history during job application, which is, in itself, grounds for dismissal. For those already employed, they keep their illness to themselves by explaining periods of prolonged absence through fake diagnoses. Patients are also faced with difficulty of finding a partner or in maintaining an existing relationship due to the unpredictability of condition, additional burden and fears of the partner (Schulze and Angermeyer 308). Effects of stigma to psychiatric care In effect, mentally ill individuals who feel devaluated and discriminated against were more likely to withdraw and be secretive, as a means of avoiding negative reactions (Link, et al. 421). Self-stigmatization, or labeling oneself despite the positive attention given to him or her by others, becomes a psychiatric issue on its own (Hinshaw and Stier 367). This mode of defense mechanism compromises psychiatric treatment, which is already subpar to begin with (Schulze and Angermeyer 305). The influence of what others think in seeking psychiatric treatment is most significant among adolescents. Since these young adults have been shown to have moderate levels of stigma and low mental health literacy, those who are mentally ill are scared of informing their friends, teachers and others in their social network. In fact, 90% of adolescents receiving psychiatric treatment have experienced stigma (Kranke, et al. 496), and it has been shown that high stigma, together with low mental health literacy, is a predictor of premature termination of mental health treatment. In fact, only 30% of adolescents with psychiatric condition seek treatment (Pinto-Foltz, et al. 2011 - 2012). . INTERVENTION TO STIGMATIZATION As seen above, the interplay of stigmatization, poor mental health treatment and lack of mental health literacy result to forgoing treatment. It is thus important that intervention may be directed to reducing stigmatization as well. Improvement of psychotropic medications One of the most logical ways of decreasing stigmatization is the provision of affordable and better-acting psychiatric drugs (Crabtree, et al. 563). In fact, carbamezapine and valproate, despite being developed in the 1970s, are still being regarded as drugs of choice in several parts of the world because of its effectiveness and affordability. Knowledge-Contact Programs Despite the increasing presence of campaigns against stigmatization and community-based psychiatric services, stigma is still prevalent (Schulze and Angermeyer 300). Knowledge-contact provides information regarding mental health together with social interaction with individuals from different groups. This has been shown to result to reduced stigma and increased literacy among adults (Pinto-Foltz, et al. 2012). Making these options more available for adolescents has been studied by Pinto-Foltz, et al. if they can improve mental health literacy, and subsequently facilitate intergroup contact with psychiatric patients. Briefly, they used In Our Own Voice, a community-based knowledge-contact intervention that uses narrative storytelling, discussion and video presentation to provide information regarding mental illness, and they conducted a survey among 156 adolescent girls aged 13 -17 years who received this intervention. However, after measurements of mental illness stigma and mental health literacy among the participants, it has been shown that only mental health literacy was improved. In addition, a long-term intervention (4 and 8 weeks) was needed to see significant improvements in mental health literacy. This is acceptable, since the study showed feasibility of retaining adolescents over 10 weeks (Pinto-Foltz et al, 2015). In spite of increase in knowledge about mental conditions, the participants, however, had the similar, stigmatized attitudes toward mentally ill individuals. Community care Instead of admission to a psychiatric hospital, administration of oral, psychotropic maintenance medications and/or enrollment into community care can help the patients avoid the stigma of being admitted into a “loony bin”. Schizophrenics and their relatives themselves believe that their care should be adequate and multidisciplinary, including in-patient treatment with after-care and re-integration services. In addition, health insurance coverage should include (Schulze and Angermeyer 306). Social identification By providing something to belong with, organizations of mentally ill individuals and relatives can also provide the emotional, intellectual and material resources to oppose the status quo of stigma and rejection. According to the social identity theory of Tajfel and Turner in 1979, individuals belonging to a positively regarded group tend to develop greater self-esteem, while members of stigmatized groups have lowered confidence (Crabtree, et al. 533). Since transferring from one group to another is not an option for individuals with psychiatric condition, they tend to seek other strategies to stop their current status of being associated with a negative group. According to Schmitt and Branscombe (167), the members of a negatively-deemed group gather their different resources to challenge the stigma, discrimination and prejudice they experience. Many studies (Reynolds, et al. as well as Veenstra and Haslam in 2000; Schmitt and Branscombe in 2002; and van Zomeren, Postmes and Spears in 2008) have been conducted since these ideas have been made in order to prove these theories, and they have shown that social identification is a significant factor in members’ opposition to stigmatization, as well as out-group’s views and actions. Similarly, Crabtree, et al. (562) has proven that social identification provided by such mental health support groups increases resistance to stigma, stereotypical rejection and increased perceived social support from out-groups. In turn, this results to increase in confidence. However, it must be noted that the noted coping strategies only mask the decline of self-esteem among the members of a stigmatized group. In addition, any of the noted positive outcomes were not apparent among a severely stigmatized group (Crabtree, et al. 563). RECOMMENDATIONS Based on the evidences of the effectiveness of various interventions against stigma presented above, it may be most effective if an interplay of these interventions. It must be noted that these, or any interventions for that matter, should be directed on dimensions of stigma that greatly affects patients and their relatives. The improvement of mental health care, including medications and facilities, should be the primary goal of intervention. Not only will it help the patients’ relatives in dealing with mental health illness, but it will also help mentally ill individuals to better control the symptoms of their disease, so that they can function better in society. In conjunction to this, changing public attitudes, through interventions such as knowledge-contact programs, can considerably help stigma. In decreasing the stigmatization of mentally-ill adolescents, such programs can also be directed to their peers, to which more than half of stigmatization experiences come from (Moses 985). Together with relatives, these friends can also serve as protective barrier to stigmatization (Kranke, et al. 496; Moses 985). However, it may be best to target the public image of mental illness, since most of what society knows about psychiatric conditions come from what they see from TV, newspaper, movies, and ads. By preventing discriminatory materials against mentally ill individuals, there is fewer factors to influence the society in prejudicing psychiatric individuals. Finally, although empowering the mentally ill by providing social identification is a good strategy, it does not solve the problem of stigmatizing public attitude. Thus, although it may increase self-esteem of psychiatric patients, there is still a prevailing stigma that can easily degrade their confidence. 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